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The 2019 coronavirus disease (COVID-19) pandemic, which was triggered by the spread of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), has caused immense damage to the global economy, as well that over 4.75 million deaths. In the absence of effective antivirals, governments have implemented a variety of non-pharmaceutical interventions ranging from shelter-in-place orders to handwashing advice in their efforts to reduce viral transmission.
New study published on the preprint server medRxiv * explores the real effectiveness of monoclonal antibodies against COVID-19 in preventing serious illness. This is an important addition to the current knowledge on the effectiveness of this therapeutic approach.
To study: Monoclonal Antibody Therapy for Covid-19 – Experiments in a Regional Hospital. Image Credit: Huen Structure Bio / Shutterstock.com
Background
As COVID-19 hit developed countries hard and fast, with hundreds of thousands of hospitalizations for severe respiratory distress and multi-organ dysfunction, new drugs and techniques were in high demand. Drugs and procedures used in the treatment of cancer, for example, were quickly re-examined for their potential usefulness in the treatment of this disease.
Among these were the class of monoclonal antibodies (mAbs), which have been developed for several autoimmune and malignant conditions. The Bamlanivimab / Etesevimab and Casirivimab / Imdevimab mAb cocktails have been shown to offer a potential benefit in reducing the severity of COVID-19 in patients with certain underlying risk factors.
These antibodies target the peak SARS-CoV-2 antigen which is responsible for virus-host cell binding via the angiotensin-converting enzyme receptor 2 (SARS-CoV-2). In order to prevent the rapid emergence of escape mutations, these antibodies must target epitopes or antigenic sites that show little or no change between variants.
Alternatively, combinations are used to prevent immune escape via mutations at one location on the spike protein. The occurrence of such a successful immune escape would favor the selection of such mutations to result in the emergence of a resistant strain.
The present study used data on the use of mAb cocktails in a regional hospital treating COVID-19 patients. The patients were informed about the therapy. All participants had more than one risk factor for poor performance and were treated within one week of receiving a positive test for SARS-CoV-2 by the reverse transcriptase polymerase chain reaction (RT- PCR) after the onset of symptoms.
Study results
The current study included 34 participants who were treated with either bamlanivimab alone or a cocktail of casirivimab and imdevimab between March and June 2021. The control group was treated with the same level of care as the recipients of antibody, with the exception of treatment with mAb.
The time from the first positive RT-PCR test to hospitalization differed between cases and controls at 9 days versus 17 days. As a result, the blood gases were weaker. Almost twice as many patients presented with a cough in the treatment cohort; however, shortness of breath on presentation was three times more common in the control group.
There was no difference in the risk of death after a positive diagnosis. Viral load was also comparable between groups, as evidenced by cycle thresholds during the course of hospitalized disease in either group.
The length of hospital stay was shortened after treatment with mAb, which was in agreement with previously published large studies. It appears that high-risk patients need to be identified early and given this drug before they develop severe symptoms, in which case MAbs can significantly reduce disease progression.
Implications
This reduction in hospital stay for survivors could be the key to avoiding the overwhelming demand from hospitals during times when the incidence of COVID-19 is increasing.
“To achieve this, we have encouraged residential physicians by mail and in the media to immediately refer their SARS-CoV-2 positive patients with significant risk factors and early symptoms to our hospital for early treatment.. “
Despite the effectiveness of mAbs in reducing time spent in hospital, no reduction in cycle cutoff values was observed. Again, 12% of cases versus 10% of controls succumbed to the disease. These results underscore the need for further studies to assess the cost-effectiveness of this therapy in saving lives and preventing serious complications in high-risk COVID-19 patients.
*Important Notice
medRxiv publishes preliminary scientific reports which are not peer reviewed and, therefore, should not be considered conclusive, guide clinical practice / health-related behavior, or treated as established information.
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